Course of the short gastric veins and their suitability for pancreatic islet transplantation

Experience is being gained with pancreatectomy for patients with chronic pancreatitis suffering intractable pain. Transplantation of pancreatic islets isolated from the patient's own pancreas reduces the amount of injected insulin required, and research aims to develop treatments to make such patients independent of administered insulin. Claims have been made that the uppermost short gastric vein runs directly to the upper pole of the spleen in about 90% of subjects and that infusion of pancreatic islets by this route would allow them to settle in the spleen. This study investigates these claims. The findings suggest that the short gastric veins are inappropriate as a route of islet administration. Most short gastric veins, including the most superior, drain to tributaries of the splenic vein. Short gastric veins passing to the spleen itself without extra-splenic connections to the splenic vein and its tributaries are relatively rare. Only four examples in 12 specimens were found, and only two of these were the most superior short gastric vein. The short gastric veins run in the fat of the gastrosplenic ligament and are most readily visible as they leave the stomach. In our 12 dissecting room specimens, the short gastric veins ranged in number from 3-17, and in diameter from 0.5-4.5 mm (mean = 1.7 mm; SD = 0.7 mm). The four short gastric veins that drained directly to the spleen ranged in diameter from 0.5-1 mm, significantly narrower than those draining to the splenic vein or its tributaries and small for cannulation.